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AP Explains: How lawmakers get their health care

WASHINGTON — Republican Sen. John McCain, a former Navy pilot who at 80 has had several health setbacks, gets his coverage from the Department of Veterans Affairs.

House leaders, like Speaker Paul Ryan, get their coverage through the Affordable Care Act, as do many members of Congress.

Congress voted to include itself in the law when it passed in 2010, and a bill passed by the House last week would continue that requirement in the new version.

So how is it working for them? Depends on who you ask.

A look at the coverage requirements for members of Congress:

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ARE MEMBERS OF CONGRESS EXEMPT?

No. While some criticize members of Congress for being out of touch, the 2010 law was specifically written to include them. Starting in 2014, members and their staffs had to use federal or state health care exchanges instead of the coverage that is available to most government workers. Most members who use the coverage buy it off the health care exchange created by the District of Columbia.

Sen. Charles Grassley, R-Iowa, pushed for lawmakers to be included in the bill. "The more that Congress experiences the laws we pass, the better the laws are likely to be," Grassley said at the time.

The same argument emerged as the House worked to rewrite the law this year. An earlier version of the Republican bill would have exempted members of Congress, drawing an outcry, but the House voted 429-0 to include themselves. That bill was passed separately from the main legislation and sponsored by Republican Rep. Martha McSally of Arizona, who said "anything short of that is hypocrisy."

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THE REQUIREMENTS

The 2010 law set up new health insurance for members of Congress and their staffs through the District of Columbia health care exchange. Most were kicked out of the Federal Employees Health Benefits Program, which government workers use.

Still, members of Congress get benefits on the exchange that many Americans don't. Even though they can't use the main government insurance program, they still get employer subsidies from the government if they use the DC exchange.

And unlike some areas where insurers are pulling out, the DC plan has a lot of options. According to a spokesman for the DC Health Benefit Exchange, lawmakers and their staffs select from 57 plans offered by four health insurance companies. There are medical services available on Capitol Hill, as well, including an attending physician who can give exams and write prescriptions.

Even if the House bill, or some version of it, becomes law, members of Congress could be protected from decreases in coverage. The House bill would allow states to obtain waivers to allow higher premiums for some people with pre-existing medical conditions and ease other consumer protections. But the District of Columbia may not seek such a waiver.

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SOME OPT OUT

Like any employer-sponsored health insurance, members don't have to use it. Some use their spouse's insurance, or insurance held over from a previous job.

McCain, who gets his health care through the VA, has had surgery for melanoma. Sen. Thom Tillis, R-N.C., says he doesn't sign up for it but thinks the options available for members of Congress "are pretty reasonable." He says he hopes others around the country will have similar options at some point.

Ryan, R-Wis., and Majority Leader Kevin McCarthy, R-Calif., both purchase insurance through the DC exchange, according to their offices. A spokesman for Senate Majority Leader Mitch McConnell, R-Ky., declined to say whether McConnell uses the exchange.

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HOW IT'S WORKING

Democrats who are highly supportive of Obama's law and signed up for the health care generally say they it has worked for them.

Sen. Claire McCaskill, D-Mo., was treated for breast cancer last year. She said her coverage was good, but noted that she lives in urban St. Louis, where there are more choices than in some of her state's more rural counties. She said she's working on legislation to allow some rural residents with no choice in plans to use the DC exchange like members of Congress do.

McCaskill doesn't take the federal subsidies and uses the national exchange rather than the DC one, because that's where Missourians sign up. She said she was pleased that Obama's health care law protects those with pre-existing conditions, as she now has.

"It certainly was reassuring that I didn't have to worry about whether they were going to take me again," she said.

Republicans are less enthused, noting that premium costs have risen for some.

"It has driven some of the good staff off because of the expense involved," McCain said.